A Brief History of Ketamine

Ketamine was first used in the 1960s a dissociative anesthetic with analgesic properties that aided in surgical procedures and later was used field anesthetic for field soldiers in the Vietnam war. While research was being collected about the anesthetic properties of ketamine, it was also noted how the medicine created hallucinogenic side effects. These hallucinogenic effects were considered undesirable for clinical practice at the time, considering its intended use was strictly to physical pain from surgery. However, since 1994, many clinical studies have found that ketamine is not only useful to relieve pain short term, but can be an effective way to treat certain chronic pain syndromes such as fibromyalgia, migraines and burns. Through administering ketamine to patients for pain relief, it was found to ease psychological pain as well.

In 2000, the first randomized, double-blinded study was published in Biological Psychiatry in which Dr. Berman et al. reported the antidepressant effects of ketamine in patients suffering from depression. In 2012, researchers called ketamine, “the biggest breakthrough in depression research in a half century.” Currently, ketamine is being used and studied with FDA approval as an "off-label" form of treatment for an array of psychiatric diagnoses such as OCD, PTSD, anxiety, and refractory or "treatment resistant" depression.

There is continued research on the positive effects of ketamine from a medicinal and psychological standpoint as psychedelic medicine becomes more mainstream in Western medicine models. Ketamine is currently being used in a variety of settings including infusion sites or IV clinics, as a take-home medicine that can be administered as a lozenge or nasal spray, and in settings where trained therapists are present and offers support throughout the preparation, during the sessions in which ketamine is consumed, and following the sessions to provide integration support to the client.

Psychedelic Therapy

Prior to the controlled substances act of 1985, psychedelic medicines were researched and used for the treatment of a variety of psychiatric conditions efficaciously. Hallucinogens such as LSD were being researched for their psychological benefits for treating psychiatric conditions such as addiction and finding promising results. However, because of the popularity and recreational use of these substances resulting in some harmful consequences and other political agendas occurring at the time, hallucinogens have been categorized as class I substances. This means that they are defined as having no medicinal use and high potential for abuse, which has resulted in the criminalization of possession and use of these substances. Because ketamine is such a safe drug and has a long history of medical use, it remained categorized as a class III drug in accordance to DEA's Controlled Substance Act.

Since then, research has continued growing by a number of institutions and universities such as Harvard, Johns Hopkins, Standford, Imperial College of London, and Multidisciplinary Association for Psychedelic Studies that support legislative change. This research has resulted in a shift in public perspective about the usefulness of some psychedelic medicines for psychological purposes. Current research for the psychological use of psychedelics has a growing focus on administering psychedelics in clinical settings to treat certain diagnosis. For more information, check out the book, How To Change Your Mind and this article for a summary.

What I feel needs to be acknowledged at this point is that hallucinogens and their psychedelic inducing qualities or non-ordinary states of consciousness, have been used in ancient civilization for entheogenic use way before Western, modern medicine. These plants and medicines that have been within cultures with deep ancestral roots were used for spiritual and psychological healing purposes long before science caught up. I feel that there is a place to honor, respect and hopefully preserve the cultures performing these ceremonies and rituals for healing and I hope that there is a place for creating more accessibility to the healing potential of psychedelics. I acknowledge that there is tension between these two fundamentally different approaches to healing and I hope that as we embark on the re-emergence of psychedelic use for healing in the Western medicine model, that there can be a place for respectful conversations about differing perspectives. The reality is there is no straight-forward answer to ultimately, ethical dilemmas.

KAP vs. Infusion/ IV clinics

The intended use of psychedelics for healing purposes is context dependent. This means that variables such as the comfort and safety of the physical environment you are in, the people you are around, the type of psychedelic you are taking, the dose, and the appropriate mindset and intentions for having these experiences will all greatly effect the impact of such experiences. Again, honoring that people have different preferences and beliefs, it is important to do some research before embarking on using psychedelics for your intended use. In order to narrow the focus in on KAP specifically, there are two main models for using ketamine as a treatment in the U.S. for various psychological purposes and one is not "better" than the other.

IV (infusion) models are typically most interested in the biological mechanisms of antidepressant qualities of ketamine. Often times, these treatments are done under the supervision of a medical professional after you have been medically cleared appropriate for treatment. These are done at sites where the medicine is administered intravenously over a duration of 1-2 hours. Often you are in a sanitary environment with a comfy lounge chair, music playing, and with the option to wear an eye mask to encourage you to go inward. Once the session is complete, you are sent on your way and recommendations and potential treatment plan is established between you and the medical provider. Often times, there is no therapist sitting with you during the administration of the ketamine sessions, nor is it required for you to process the experience with someone afterwards. There is ample research and evidence to support the use of infusion treatment especially in the case of easing depression symptoms and the onset of suicidal ideation. The immediate medicinal effects can be powerful enough to shift perspectives from hopeless to one with some space from the pain and potentially new motivation to pursue ongoing support. This treatment approach can be more cost efficient, can be a life-saving intervention when experiencing acute depression, and a good fit for those who may have a therapist that they can connect with after the ketamine experience to process and integrate the experience with. For more information about this treatment option, check out this article.

KAP administered in settings in which therapeutic support is a key component to the process and differs from most infusion model in several ways. First, there is an emphasis on the therapeutic relationship and process to really create a customized and safe container for the client's process. There is often more of a team-approach in which the client, therapist, and medical provider are in communication with one another and collaborating throughout the course of the treatment. There is more opportunity for continuity of care and focus on the client's unique needs. The process starts with the client sharing a thorough history and an assessment is completed with both the therapist and the medical provider so that the professionals can recommend and tailor the treatment plan to the participant. Right from the beginning of the process, the therapist and provider's goals are to build a trusting and safe relationship with the client. Once determined that ketamine is an appropriate course of treatment, the medial provider prescribes the ketamine in whatever form that they use (we use lozenges or intramuscular shots), and the therapist starts to work with the client on treatment goals and preparing the client for the psychedelic therapy experience. The therapist sits with the client during their 2-3 hour ketamine sessions offering guidance and support the whole time. 24-72 hours following the ketamine session, the therapist and client then process the experience and connect it back to their treatment goals. The therapist may make further recommendations depending on what comes up during the ketamine session for therapeutic modalities that will compliment and enhance the process such as encouraging the client to engage in Somatic Therapy, EMDR, or spiritual counseling. The whole process follows a sequence of "Preparing", "Experiencing", and "Integrating". This route of treatment is especially recommended for individuals seeking a deep, rich, therapeutic experience in which having a professional guide the whole way potentially helps to create lasting change and sustained results from the treatment. Because of the thoroughness of the coordination of care and therapeutic support, this treatment option tends to be more expensive, but again, has a high potential for creating lasting change that makes it a worthy investment.

This is a stock photo on from the internet of what KAP sessions may look like

Working with AIP- Nature Connection and 4 Session Model

Nature Connection: I work with specifically with Asheville Integrative Psychiatry (AIP) located in Candler, NC on 16 acres of wooden oasis. I work intimately with the team at AIP following their mission to provide quality care in a friendly, and natural environment. As the field of psychedelic therapy grows, the research supporting infusing nature connection throughout the therapeutic process, shows that nature connection and psychedelics have synergistic effects that can create sustained and lasting results. The hope is to use the ketamine as a relatively short term intervention that will help the participant get unstuck, move past trauma, and offer new space, motivation, or shifted perspective towards health and wellness. This differs from the traditional Western medicine model of prescribing medication without a goal for getting off of them. With KAP, when the medicine has left the body, our goal is to connect clients to resources that will continue the progress that they made. There is a dance that is done between fully immersing in a medicine experience and then practicing and applying the lessons learned from the experience so that we can continue to move forward with our lives in adaptive and healthy ways. By learning new coping skills, prioritizing self-care, seeking more balance, and using time spent connecting with nature and our roots, we can access the inner peace and wisdom that may be found in psychedelic experiences and take it with us anywhere we go. Thus we dance between allowing a journey to unfold and taking action as we put one foot in front of the other. Check out this article about Nature Therapy and Psychedelics and this research paper on the Synergistic Effects of Nature Connection and Psychedelics.

4 Session Model: AIP uses a 4 session model to provide the participant with the opportunity for two main reasons. First, it is industry standard when using ketamine to treat depression to start with an initial "ramp up" of the medicine in order to support the opportunity for disrupting neuroticism, rigid negative default thinking patterns, and the freeze response associated with nervous system when overwhelmed and depressed. This means that at infusions sites and in KAP oriented programs, there is evidence to support having sessions 1-2 times per week over the course of 4- 6 weeks in order to give the medicine the opportunity to shake things up essentially. The second main reason for having multiple sessions, is to allow the client the opportunity to go deeper with their process and create opportunities for lasting changes. While 1 session may be enough to shake things up, offer a new perspective, or to get unstuck from a certain issue, often times, clients report that more than one session provides gives them the opportunity to really launch into a new way of being and an overall shift to a regulated nervous system. AIP starts off all clients with an initial session administered sublingually and then there are options to continue with sublingual route of administration or switch to intramuscular shot for the remaining 3 sessions. AIP has established different protocols in terms of dosing amount and recommended route of administration depending on the client's unique needs and the whole team will collaborate with client about this as we go. A medical staff will be tracking your response to the medicine at the beginning and end of every session and are onsite during your medicine sessions.

I encourage anyone wanting to do this work with me to read over AIP's website in conjunction with mine!

These are pictures of the AIP retreat space and treatment spaces for KAP sessions to be in contact with nature

Working with Skylight Psychedelics- in AVL office 6-session model

Therapeutic Relationship Focus: I also work with Skylight Psychedelics to offer customizable treatment plans that occur in my office in downtown Asheville. The intention and focus in my work with clients is always to be in authentic relationship with my clients and use collaborative approaches to addressing your goals with engaging in KAP. Skylight only works with therapists who have taken their training with a mission to make KAP more accessible to clients who have a good relationship with a trained therapist. Skylight requires that in order to acquire a prescription from them, you agree to take your medication in the presence of a licensed and trained KAP therapist. While I will still encourage nature connection and embodiment practices while working with Skylight, they also provide integration through yoga videos and connecting with other community members who engage in KAP.

6 Session Model: After being evaluated and approved as an appropriate client for KAP, Skylight providers will mail you an initial dose administered sublingually. One of the providers will ask you to reach out to them 24-48 hours after your first session to check-in and assess how you responded to the medication and determine appropriate amount and dosage protocol for 5 more sessions. The medicine will then be mailed to you. It will be up to me and you to create a customized schedule for the course of your treatments in my office. Because there is no medical monitor present, this model is best suited for individuals who are comfortable with engaging with ketamine as a psychedelic with only me present. Often times, these sessions are for individuals who have gotten established with me a client and will continue to work with me for several sessions before and after the KAP protocol.

These are pictures of my office in Asheville

AIP or Skylight

Determining Best Fit is a Collaboration: During an intake assessment with me, we will start to determine the best setting for your KAP experience in a collaborative manner. Here are some things that I recommend we consider together when assessing each option.

AIP

Skylight

• Holistic model approach and offers integrative psychiatry services for those seeking to decrease or get off of medication (when appropriate). KAP can be used to assist in this process

• Team approach throughout KAP protocol, meaning that the office manager, the medical staff, therapist, and client work in tandem together, in person as we take each step in the process.

• A medical person is present during KAP sessions and check in with clients before and after each medicine administration.

• The setting is natural, offering space to engage in mindfulness outside or insight of nature and there is ample space to truly release and express as you need to. For example, the spaces are private enough that no matter how audible you are, the natural setting will diffuse and transmute your expelled energy.

• There are options to engage with ketamine sublingually or intramuscularly and medication is stored on site at AIP.

• Because of setting and team approach to treatment, the cost is on the higher end of the pricing scale on my pricing page.

• Additional FAQ's on AIP's website:

• Collaborative approach with physician, therapist, and client although physician will meet with client via telehealth and not in person.

• Medication is sublingual only and best suited for individuals who are comfortable being mailed medication and storing it at their house. Clients will be responsible for remembering to bring their medication to sessions.

• The setting is comfy and cozy indoors with plants, art, and salt lamp. Location may be more convenient as office is located in Asheville.

• Because the office is a shared office building, clients will be encouraged to express themselves as needed, say loud audible expression, but may need to use adaptive therapeutic tools such as expressive breath work or gentle movement. Pillows, yoga mats, and bolsters may assist in this process.

• Client must feel comfortable not having a medical staff present during medicine sessions. It will be only me and the client. Thus, this is often best suited for clients who are established with me as routine therapy clients and/or individuals who have previous experience with ketamine therapy.

• If an established client with me already, costs may be on the lower end of the pricing scale on my page.

• Additional FAQ's on Skylight's website: